- ICH GCP
- Registro de ensayos clínicos de EE. UU.
- Ensayo clínico NCT01773629
Care Managers for Perinatal Depression (CMPD) (CMPD)
The investigators will evaluate effects of introducing the care manager on:
- Patient receipt of timely diagnosis and initiation of treatment for major depression (diagnosis within 2 weeks of screening and treatment within 1 month of diagnosis); and
- Patient continuity of care for depression across the transition of care from pregnancy to postpartum (within 4 months postpartum).
Descripción general del estudio
Estado
Condiciones
Intervención / Tratamiento
Descripción detallada
The first two specific research aims of this proposed randomized study will evaluate the benefits of introducing site specific care managers into established multi-component enhancements of perinatal depression care. The four study sites are members of the IMPLICIT perinatal quality improvement network and provide prenatal care to a diverse population of low income minority women using a common set of care processes within diverse practice models including Obstetric, Family Medicine, and Nurse Practitioner/Midwifery settings. The established processes of care include evidence based screening, diagnosis, treatment protocols and quality improvement care teams.
The investigators will evaluate effects of introducing the care manager on:
- Patient receipt of timely diagnosis and initiation of treatment for major depression (diagnosis within 2 weeks of screening and treatment within 1 month of diagnosis); and
- Patient continuity of care for depression across the transition of care from pregnancy to postpartum (within 4 months postpartum).
For the third and fourth specific research aims we will conduct supplementary econometric and qualitative analyses to aid in understanding the provider and system context in which this intervention is implemented across the four study sites. Results of this evaluation will be used to understand for whom and in which systems of care this model is most successful as well as the costs of delivering this intervention.
Specifically the investigators will:
- Employ econometric techniques to quantify the costs of implementing and maintaining the IMPLICIT collaborative care maternal depression intervention; and
- Develop institutional ethnographies of the four study sites and identify factors associated with relative success in implementing perinatal depression care managers and improving timely diagnosis, initiation, and continuity of depression care.
Achieving these aims will provide the foundation for dissemination of this innovative approach to perinatal depression care delivery throughout the entire growing IMPLICIT network which now extends across the northeast and mid-Atlantic regions of the US; sites which provide perinatal care for low income minority women in urban, rural, and suburban communities. These sites include prenatal practices in the Robert Wood Johnson Foundation Aligning Forces for Quality initiative, the Healthy York County Coalition which is partnering with us to disseminate this work in their region.
Tipo de estudio
Inscripción (Actual)
Fase
- No aplica
Contactos y Ubicaciones
Ubicaciones de estudio
-
-
Pennsylvania
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Lancaster, Pennsylvania, Estados Unidos, 17604
- Downtown Family Medicine
-
Lancaster, Pennsylvania, Estados Unidos, 17608
- Southeast Lancaster Health Services
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Philadelphia, Pennsylvania, Estados Unidos, 19122
- Broad Street Health Center
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Philadelphia, Pennsylvania, Estados Unidos, 19139
- Haddington Health Center
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-
Criterios de participación
Criterio de elegibilidad
Edades elegibles para estudiar
Acepta Voluntarios Saludables
Géneros elegibles para el estudio
Descripción
Inclusion Criteria:
- Female
- Current pregnancy or experienced pregnancy in the past 6 weeks
- Score >= 12 on PHQ9
Exclusion Criteria:
- < age 13
- Mental illness
- Primary language other than English or Spanish
Plan de estudios
¿Cómo está diseñado el estudio?
Detalles de diseño
- Propósito principal: Investigación de servicios de salud
- Asignación: Aleatorizado
- Modelo Intervencionista: Asignación paralela
- Enmascaramiento: Ninguno (etiqueta abierta)
Armas e Intervenciones
Grupo de participantes/brazo |
Intervención / Tratamiento |
---|---|
Experimental: Intervention
Participants in the intervention arm will receive standard care plus the addition of a care manager.
Care managers will function to provide culturally competent and linguistically appropriate support for the care of women identified as being at high risk for depression in pregnancy.
Working with both the care providers and these study participants care managers will serve as connectors, coaches, collaborators, and negotiators working to overcome barriers to depression care delivery.
|
Participants in the intervention arm will receive standard care plus the addition of a care manager.
Care managers will function to provide culturally competent and linguistically appropriate support for the care of women identified as being at high risk for depression in pregnancy.
Working with both the care providers and these study participants care managers will serve as connectors, coaches, collaborators, and negotiators working to overcome barriers to depression care delivery.
|
Otro: Control
Standard of care: within the current care processes, a woman initiating prenatal care completes a depression risk assessment using a two-step approach.
Women with high risk of depression are then scheduled for a separate visit with a member of the care team (a physician, psychologist, or other mental health provider) referred to as a "perinatal depression champion" for a timely formal diagnostic interview.
|
Standard of care: within the current care processes, a woman initiating prenatal care completes a depression risk assessment using a two-step approach.
Women with high risk of depression are then scheduled for a separate visit with a member of the care team (a physician, psychologist, or other mental health provider) referred to as a "perinatal depression champion" for a timely formal diagnostic interview.
|
¿Qué mide el estudio?
Medidas de resultado primarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
---|---|---|
Diagnosis of major depression within 2 weeks of screening
Periodo de tiempo: 2 weeks after screening
|
Patient receipt of timely diagnosis for major depression during perinatal period.
|
2 weeks after screening
|
Treatment of major depression within 1 month of diagnosis
Periodo de tiempo: 1 month
|
Patient receipt of timely initiation of treatment for major depression during the perinatal period.
|
1 month
|
Transition of care from pregnancy to postpartum
Periodo de tiempo: 4 months
|
Patient continuity of care for depression across the transition of care from pregnancy to postpartum within 4 months postpartum.
|
4 months
|
Medidas de resultado secundarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
---|---|---|
Quantify the costs of implementing a care manager
Periodo de tiempo: 3 years
|
Employ econometric techniques to quantify the costs of implementing and maintaining the care manager for managing perinatal depression.
|
3 years
|
Qualitative assessment of success in implementation of perinatal depression care management process.
Periodo de tiempo: 3 years
|
Develop institutional ethnographies of the study sites and identify factors associated with relative success in implementing perinatal depression care managers and improving timely diagnosis, initiation, and continuity of depression care.
Qualitative measures include efficacy of core implementation group, commitment of implementation group, commitment of user group and readiness to change.
|
3 years
|
Colaboradores e Investigadores
Patrocinador
Investigadores
- Investigador principal: Stephen Ratcliffe, MD, MSPH, Lancaster General Hospital
- Investigador principal: Ian M Bennett, MD, PhD, University of Pennsylvania
- Investigador principal: Donna Cohen, MD, MS, Lancaster General Hospital
- Investigador principal: Michael A Horst, PhD, MPHS, MS, Lancaster General Hospital
Fechas de registro del estudio
Fechas importantes del estudio
Inicio del estudio
Finalización primaria (Actual)
Finalización del estudio (Actual)
Fechas de registro del estudio
Enviado por primera vez
Primero enviado que cumplió con los criterios de control de calidad
Publicado por primera vez (Estimar)
Actualizaciones de registros de estudio
Última actualización publicada (Estimar)
Última actualización enviada que cumplió con los criterios de control de calidad
Última verificación
Más información
Términos relacionados con este estudio
Palabras clave
Términos MeSH relevantes adicionales
Otros números de identificación del estudio
- 2010-38-LGH
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